Health secretary in waiting

Authors: Kathy Oxtoby 

Publication date:  07 Oct 2009

Kathy Oxtoby speaks to Andrew Lansley, the Conservative shadow secretary of state for health, about his plans for the NHS if the Tories win next year’s election

Andrew Lansley is a health secretary in waiting. The Conservative shadow secretary of state for health has been waiting six years, during which time he has watched a parade of Labour politicians take the position then be promoted, sidelined, switch roles, or leave politics altogether.

While formulating Tory policy he has seen how Labour has handled health care. Now, with polls regularly predicting a Conservative victory at the next election, he feels his experience has sufficiently informed his ideas on how the health service should be run. “If I make mistakes in the future, they won’t be born from ignorance,” he says.

History in health

Mr Lansley’s interest in health issues began at an early age—his father worked in the NHS from the day it was created in 1948 and went on to run the pathology laboratory at East Ham Memorial Hospital for 30 years. On entering parliament as an MP for South Cambridgeshire in 1997, Mr Lansley carried on that interest, becoming a member of the Health Select Committee.

The Labour landslide of that year, Mr Lansley recalls, is “scarred in my memory. We lost because the public felt we didn’t care sufficiently about the quality of public services people received.”

But he continued to pursue a political career in health care, becoming shadow health secretary in 2003, because, he says, “I have no doubt there is more potential for us to make a positive difference to people’s lives by improving the overall performance of the health service than in any other single area.”

One way he hopes to improve the NHS is by having a more effective public health infrastructure. “We are determined the DH [Department of Health] will be ‘the Department of Public Health,’” he says. Ring fenced funding will help deliver on public health objectives like obesity and alcohol and drug misuse—areas which he believes “are getting worse and need to improve.”

NHS board

Another Conservative priority will be to create an independent NHS board, which would be responsible for dividing up NHS funds between different parts of the country away from ministerial meddling. The new body would aim to allocate money fairly and in a way that will help secure equal access to health care for all.

To those concerned that such a body still smacks of political interference, Mr Lansley stresses the board wouldn’t “own” the NHS, but would be an autonomous organisation. He explains it would focus on looking at commissioning and allocating resources to improve outcomes for, say, cancer and stroke patients, with input from bodies like the National Institute for Health and Clinical Excellence.

Making services more accountable to patients is high on the Conservative Party’s health agenda. Despite the fact that doctors understand what patients want and need, “the trouble is the system doesn’t seem to work,” says Mr Lansley. He wants patients to have greater control over their health care, from choosing their general practitioner to having access to more transparent information about the quality of their services.

Choose and Book

A more responsive NHS that delivers on patient choice sounds familiar. But when asked about Labour’s attempts at making the health service more responsive to patients’ needs with Choose and Book, Mr Lansley dismisses the scheme as “a failure.”

“We should be talking about an effective patient appointment system that allows them access to good quality information and providers. Instead it is a demand management system.” The information available on Choose and Book is “lamentable” he believes, and fails to give infection rates in hospital, readmission rates, and long term outcomes—the vital details patients want.

Recession impact

Should Mr Lansley have the opportunity to start realising his party’s healthcare vision come the next election, it’s likely the country will still be in recession and health will inevitably be forced to compete with other sectors for its share of public funding. Medical leaders have already voiced concerns about health cuts. At this year’s BMA Annual Representative Meeting, council chairman Hamish Meldrum said he feared that the NHS and the profession were “facing some of the biggest and most serious challenges ever, as we move from a period of sustained growth in resources to one of, at best, stagnation in funding, and at worst, stringency, hardship, and even cuts in the health service.”

Such concerns are unfounded, Mr Lansley believes, because money wise the NHS has never had it so good. “It’s astonishing that at a moment when NHS resources are continuing to rise faster than any time in history, the BMA has started to complain about lack of resources,” he says.

For the shadow health secretary, the real challenge will be to find ways to use NHS resources more effectively. Mr Lansley advocates “stripping out bureaucracy and eliminating waste” to ensure resources get to the front line and to boost productivity.

Doctors’ contracts

The challenge for the BMA, he says, is to ask, “Why do we have GP [general practitioner] and consultant contracts which have failed to secure productivity improvements?” Although he “doesn’t want to impose on these contracts,” he does believe consultants must deliver on productivity and that GPs need to deliver better results, to show taxpayers that the NHS is giving them good value for money.

Under a Conservative government, clinicians will become more productive because they will have control of patient care and “the opportunity to demonstrate their innovation and enterprise,” Mr Lansley says.

He does not intend to take the politics out of the NHS—such a claim “would be foolish.” But he does want to take away the day to day political interference, such as the issuing of numerous, unnecessary targets like the 18 week waiting limit, which he describes as “an abuse of NHS staff.”

“To suggest that if this target was removed patients would be forced to wait for years implies that people in the NHS don’t care. In reality, as long as patients are able to exercise choice we will find a continuing downward pressure on waiting times.”

Practice based commissioning

Trusting in the ability of healthcare professionals to deliver the services patients want and need is central to Tory health policy. But surely Labour could say the same, given that approaches like practice based commissioning are designed to give GPs more responsibility for patient care?

For Mr Lansley, practice based commissioning doesn’t go far enough in terms of giving control to clinicians. He says the approach has “stalled” and that there is “plenty of evidence that many PCTs [primary care trusts] have taken practice based commissioning off their agenda.”

What is needed, he suggests, is an approach that allows frontline practices to be “genuinely responsible” for commissioning care. He would like to see GPs have the opportunity “to be more innovative, more efficient and to use resources for the benefit of patients.” For that to happen he wants GP commissioners to be able to “exercise control over their budgets. If GPs have genuine freedom to use budgets more efficiently they are going to make considerable gains in health terms.”

Mr Lansley believes that money for practice based commissioning schemes should be kept separate from practice funds. However, GPs running commissioning projects who persistently overspend would potentially “lose the ability to manage their funding.”

Out of hours

Putting GPs in charge of out of hours care is one way that Mr Lansley would give control of care back to clinicians. However, he stresses that GPs’ responsibility for patients “shouldn’t stop at 6 30 pm.” This would not mean a return to the “bad old days” of their being individually accountable for such care. Giving GPs control of commissioning budgets, he says, would allow them to shape out of hours standards, making services “more flexible and effective.”

Under Labour, primary care has been a key focus. Polyclinics and GP led centres have been central to the party’s drive to move care closer to home. Mr Lansley says the Tories have made clear that should they win the next election they would not scrap contracts. But he says his party would aim for these organisations “to have the same kind of contract as other GP practices. If they have a contract for services beyond GMS [general medical services], then GPs should have to compete for it alongside others.”


Introducing more competition in the healthcare sector would be welcomed by healthcare professionals, Mr Lansley believes. “When I talk to GP practices, foundation trusts, and NHS trusts, they don’t object to competition—they object to distorted competition.”

Having more competition in health care is likely under a Conservative government. Although Mr Lansley stresses the party is “not looking to transfer assets out of the NHS,” he says that it would “like to maximise opportunities for the health service to benefit from new investment.

“That means giving the independent sector real opportunities to provide services to be innovative and efficient, but they need to be on a fair, competitive basis,” he says.

Working hours

Although the Conservatives may want to empower clinicians and raise the standard of patient care, the European Working Time Directive, Mr Lansley says, is “arguably undermining continuity of care and training, and, to some extent, the quality of service for patients.”

Junior doctors are supposedly able to opt out of the 48 hour week, “but for many it doesn’t seem like that,” Mr Lansley says. He believes a maximum of a 56 hour week is “entirely reasonable,” and he would like junior doctors’ hours to be managed more flexibly within that time scale.

At a time when the effectiveness of the junior doctors’ contract is being assessed by the NHS Executive, the shadow health secretary says he is “only too aware of the damage that has been done to confidence of the medical profession by the MTAS [medical training application service] debacle.”

Mr Lansley, who takes pride in being the only politician who joined the junior doctors’ march in 2007 to protest against MTAS, views the medical training application process as “a disaster that has driven potential doctors out of the profession.”

The fallout has been that the medical profession has gone “from feast to famine,” and now there is a “chronic undersupply” of junior doctors in some specialties, whereas in disciplines like surgery there are “serious reservations about whether people will be able to become independent specialists, which should never be the case.” To solve junior doctors’ training difficulties, Mr Lansley wants the profession to be given greater control of medical education and for Labour to act on Professor John Tooke’s recommendations on how it should be structured—as yet his report remains “a very positive opportunity the Government hasn’t used,” he says.

None of these recommendations needs involve major organisational upheaval within the NHS, but they would require politicians to stop controlling the health service.

“Let go”

“I’ve spent nearly six years listening to what are often strong views about what the health service should be providing, and what I’ve learnt is that to get the best possible results, politicians should stop trying to make all the decisions and let go,” he says.

Letting go will involve handing over power to clinicians, but this will require the medical profession “to respond to this opportunity.”

“Instead of waiting around for the next circular from the DH, it’s about saying here is a chance to deliver the service we’ve always wanted in a way we’ve wanted to.”

So the future of the NHS, he says, should be put “in the hands of clinicians.” Whether Mr Lansley’s vision will be realised will be in the hands of the voters.

Positions held

  • Shadow secretary of state for health, November 2003

  • MP for South Cambridgeshire, May 1997

  • Vice president of the Local Government Association, 1996

  • Shadow minister for the Cabinet Office and Policy Review, June 1999 to September 2001

  • Vice chairman of the party responsible for policy renewal, May 1998

  • Director of the Conservative Research Department, 1990-5

  • Deputy director general of the British Chambers of Commerce, 1987-90

  • Principal private secretary to the Rt Hon Norman Tebbit MP, 1984-7

Competing interests: None declared.

Kathy Oxtoby freelance journalist London

Cite this as BMJ Careers ; doi: